Jatayvia Jaqae Jackson, LLMSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6851115529 Issued in MI

Practice address

3253 Congress Ave
Saginaw, MI 48602-3106

Phone

(989) 475-4171

Fax

(989) 393-6021

NPI assigned

May 2, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Jatayvia Jaqae Waller Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1525219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680912000000",
    "number": "1174012389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32100 TELEGRAPH RD STE 205",
            "city": "BINGHAM FARMS",
            "state": "MI",
            "postal_code": "480252454",
            "telephone_number": "248-712-4266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3253 CONGRESS AVE",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486023106",
            "telephone_number": "989-475-4171",
            "fax_number": "989-393-6021"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "32100 Telegraph Rd Ste 205",
            "address_purpose": "LOCATION",
            "city": "Bingham Farms",
            "state": "MI",
            "postal_code": "480252454",
            "country_code": "US",
            "telephone_number": "248-712-4266",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "JATAYVIA",
        "middle_name": "JAQAE",
        "credential": "LLMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-02",
        "last_updated": "2023-04-08",
        "certification_date": "2023-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "156F00000X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6851115529",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JATAYVIA",
            "last_name": "WALLER",
            "middle_name": "JAQAE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Asha Jackson
• Ashley Nicole Jackson
• Aundrelia Jackson
• Brittany Jackson
• Gianna Jackson
• Lakeshia Jackson, NURSE PRACTITIONER
• Madeline Michelle Jackson, BEHAVIOR TECHNICIAN
• Marciano Jackson
• Matthew Brennan Jackson
• Morgan Jackson

• Clinical Social Worker in Saginaw, MI
• Providers in Saginaw, MI by specialty
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.